Uninsured consumers that will be eligible to purchase health insurance in exchanges in 2014 are different from those who have commercial coverage today. They are different in many key areas that will impact their likelihood to purchase insurance in an exchange and the type of coverage they might purchase:
- Over 45 years of age. Almost half are between 45 and 64 years of age.
- Less educated. Almost 50% have a High School education or less (twice as many did not go to college compared to the insured).
- Less healthy. Although not necessarily in bad health, only 35% of uninsured say they are in “excellent” (8%) or “very good” (27%) health compared to over 50% of commercially insured consumers who gave these responses. Only 6% of the uninsured say they are in “poor” health, but 19% say their health is only “fair.”
- Less engaged in their health. The uninsured score significantly lower on the DSS Health Care Engagement than do the insured counterparts (51 vs. 64 out of a possible 100 points). The uninsured are significantly less likely to say they are actively involved in maintaining good health and one-third say they never engaged in any activities to monitor or treat a known chronic condition.
- More likely to smoke. Almost 46% of the uninsured say they currently smoke compared to 24% of insured consumers. Only one-third of the uninsured have never smoked (52% of insured have never smoked).
- Have slightly fewer diagnosed conditions. Although 49% of the uninsured report having one more serious chronic conditions (compared to 60% of the insured), these conditions may be under-reported due to less engagement and fewer doctor visits to make such diagnoses.
- Average BMI is equal to insured consumers. Although BMI has been called into question as an effective measure of health (see recent AMA meta study showing overweight people live longer than normal weight people), the average BMI for uninsured consumers is solidly overweight (27.9 BMI) as is the average for insured consumers (27.2 BMI). Uninsured consumers do tend to have more underweight and obese BMI levels and fewer people with a “normal” BMI compared to the insured.
- Have fewer doctor relationships. Only 50% of uninsured report having a personal physician (compared to 86% for insured). Only 58% of uninsured consumers visited a physician in the past year whether they have a personal doctor or not (compared to 88% of the insured).
- Emergency room usage is no different. Amongst those uninsured consumers with some income and the wherewithal to make their own health care decisions, ER over-utilization does not appear to be a problem. Only 30% of the uninsured visited an ER in the past year compared to 25% of the insured.
- Do not visit the dentist. Only one-quarter of the uninsured visited a dentist at least once in the past year, compared to 75% of the insured who visited a dentist for a check-up or cleaning.
- Less knowledgeable and more negative regarding reform. Very few consumers in general consider themselves knowledgeable about reform, but 17% of the uninsured have never heard of health reform or PPACA and another one-third know nothing about it. Amongst those aware of reform, the uninsured are slightly more negative regarding its potential impact despite the law’s intent to help this group more than any other. Only 22% of the uninsured said they would prefer to seek coverage through an health insurance exchange (compared to 27% of the insured, a small, but statistically significant difference).
- Most are employed. Only 40% of the uninsured are unemployed or retired.
- More likely to be single or divorced . Almost 38% are single and 21% are divorced (compared to 26% and 10% of the insured respectively).
In summary, while the uninsured appear on the surface to be only slightly less healthy, due to under-utilization of preventive, dental and routine physician care, they may have more hidden or undiagnosed conditions. They are less engaged in their health care, less knowledgeable about health reform and disinterested in health insurance exchanges, which may lead many of the uninsured to remain without health insurance in 2014 and beyond.